Effect of Applying Cuff Air Leak Pressure as Intraoperative Cuff Pressure on Postoperative Complications

Background: The objective of the study was to study the clinical profile, incidence of postoperative complications in patients undergoing pleural decortication.Methods: The subjects for the study were selected from the cases admitted in a single unit of Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad during the period of 2016 to 2018 and due ethics committee approval was taken. Collection of data is done from the database including admission record, ICU charts, discharge records and follow-up records. 50 patients underwent surgery. Outcomes and complications were analyzed for 3 years duration.Results: 50 patients were included in this study with different aetiologies that required pleural decortication. The average age of patients in our study was 34 years. Most patients in our study were male (80%) and had history of infection with tuberculosis (42%) and pyogenic (28%) infection. A few patients had history of trauma (12%). Most of the patients suffered from cough (88%), dyspnoea (74%), fever (82%) and haemoptysis (22%). The common postoperative complications we encountered were pleural air leak (37.5%) bleeding (25%) infection (25%) and recurrence (2%). Overall morbidity from pleural decortication was seen in 16 patients, and there was no mortality.Conclusions: The most common reason for pleural decortication is still empyema thoracis secondary to infection in the developing countries. Tuberculosis is still the most common cause leading to fibrothorax requiring pleural decortication followed closely by pyogenic lung infections and trauma.

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A randomized comparison of the Laryngeal Mask Airway Supreme™ and Laryngeal Mask Airway Unique™ in infants and children: does cuff pressure influence leak pressure?

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2013.12.006 ◽

2014 ◽

Vol 26 (2) ◽

pp. 167-168

Author(s):

Narasimhan Jagannathan ◽

Lisa Sohn ◽

Katherine Sommers ◽

Dawn Belvis ◽

Ravi D. Shah ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Cuff Pressure ◽

Infants And Children ◽

Laryngeal Mask ◽

Leak Pressure ◽

In Infants And Children ◽

Laryngeal Mask Airway Supreme

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Changes in endotracheal tube intracuff pressure and air leak pressure over time in anesthetized Beagle dogs

Veterinary Anaesthesia and Analgesia ◽

10.1016/j.vaa.2018.06.005 ◽

2018 ◽

Vol 45 (6) ◽

pp. 737-744 ◽

Cited By ~ 1

Author(s):

Chi Won Shin ◽

Won-gyun Son ◽

Min Jang ◽

Hyunseok Kim ◽

Hyungjoo Han ◽

...

Keyword(s):

Endotracheal Tube ◽

Intracuff Pressure ◽

Leak Pressure ◽

Beagle Dogs ◽

Air Leak ◽

Over Time

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Using tissue glues for decreasing alveolar air leak in thoracic surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319841734 ◽

2019 ◽

Vol 27 (5) ◽

pp. 369-373 ◽

Cited By ~ 1

Author(s):

Amr M Allama ◽

Montaser E Abd Elaziz

Keyword(s):

Postoperative Complications ◽

Lower Incidence ◽

Air Leak ◽

Alveolar Air ◽

Pulmonary Surgery ◽

Significant Difference ◽

Prolonged Air Leak ◽

Glubran 2 ◽

Short Time ◽

Sealant Group

Background Prolonged air leak is one of the most annoying complications after pulmonary surgery. Studies have shown that patients with more intraoperative air leaks are at higher risk of developing prolonged postoperative air leak. Various types of sealants have been used effectively for decreasing intraoperative alveolar air leak. We decided to compare 3 sealants to determine which was best. Methods This was a prospective nonrandomized study that included 120 patients undergoing pulmonary surgical procedures associated with intraoperative air leak. They were divided into 4 equal groups. In the first group, no sealant was used. Glubran 2 sealant was used in the second group, BioGlue in the third, and TachoSil in the fourth. Results Preoperative and intraoperative data showed no significant differences among groups, except age which was significantly older in the BioGlue group. Air leak duration and tube duration were significantly shorter in the sealant groups, separately and collectively. No significant difference was found among groups regarding total tube drainage. Also, no significant difference was found between the no-sealant and sealant groups collectively regarding the incidence of postoperative complications, but the BioGlue group had a significantly lower incidence of postoperative complications compared to the no-sealant group. Postoperative hospital stay was significantly shorter in the sealant groups, separately and collectively. Conclusion Our results support the use of sealants for decreasing alveolar air leak. They were easily used in a short time with no significant superiority of one sealant over the others, except for a lower incidence of postoperative complications with BioGlue.

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Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2018-026606 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026606

Author(s):

Eugene Kim ◽

In-Young Kim ◽

Sung-Hye Byun

Keyword(s):

Observational Study ◽

Thoracic Surgery ◽

Endotracheal Tube ◽

Cuff Pressure ◽

Air Leak ◽

Double Lumen ◽

Double Lumen Endotracheal Tube ◽

Bronchial Cuff ◽

Lateral Decubitus ◽

Lateral Positioning

IntroductionCorrect pressure is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. An inadequate bronchial cuff pressure (BCP) can cause air leak and interfere with visualisation of the surgical field, whereas an excessive pressure BCP can lead to cuff-related complications. Based on several reports that cuff pressure could alter after a positional change when using an endotracheal tube, we hypothesise that a change from the supine position to the lateral decubitus position, which is essential for thoracic surgery, would affect the BCP of the DLT.Methods and analysisThis prospective, single-centre, observational study will enrol 74 patients aged 18–70 years undergoing elective lung surgery from September 2018 to April 2019. The primary outcome will be the change in the ‘initially established BCP’ (maximum BCP not exceeding 40 cm H2O with no air leak in the supine position) after lateral decubitus positioning. BCP and air leak will be assessed in each patient position during inflation of the cuff with air in 0.5 mL increments from 0 to 3 mL. Secondary outcomes will include the incidence of BCP exceeding 40 cm H2O after the initial established value and that of a change in the smallest bronchial cuff volume without air leak after a change to the lateral position. The relationship between the change in BCP and airway pressure, compliance and body mass index after lateral positioning will be investigated.Ethics and disseminationThe study will be conducted in accordance with the Declaration of Helsinki and supervised by the Daegu Catholic University Medical Center institutional review board (study approval number CR-18–111). All patients will receive information about the study and will need to provide written informed consent before enrolment. The results will be presented at an international meeting and published in a peer-reviewed journal.Trial registration numberNCT03656406; Pre-results.

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Acquired Tracheal Diverticulum as an Unexpected Cause of Endotracheal Tube Cuff Leak

The Journal of Critical Care Medicine ◽

10.1515/jccm-2015-0024 ◽

2015 ◽

Vol 1 (4) ◽

pp. 171-173 ◽

Cited By ~ 1

Author(s):

René Agustin Flores-Franco ◽

Jesús Silva-Alcaraz

Keyword(s):

Endotracheal Tube ◽

Cuff Pressure ◽

Ventilatory Support ◽

Structural Defects ◽

Chronic Obstructive ◽

Intracuff Pressure ◽

Air Leakage ◽

Air Leak ◽

Tube Cuff ◽

Tracheal Diverticulum

Abstract Introduction: Tracheal diverticulum has been associated with problems during endotracheal intubation but there are no reports concerning air leakage around an endotracheal tube (ETT). Case report: The case of an elderly woman under mechanical ventilatory support because an exacerbation of chronic obstructive pulmonary disease (COPD) is reported. She presented with an inexplicably air leak around the endotracheal tube not attributed to structural defects. The intra-cuff pressure value was as high as 30 mmHg to prevent an air leakage. Bronchoscopy revealed a tracheal diverticulum at the site ofthe tube cuff that allowed air leakage around it. The problem was overcome by re-intubating the patient with a larger diameter tube and positioning its distal end above the diverticular opening. Discussion: Endotracheal tube air leak is a frequently neglected problem. COPD and other inflammatory conditions are associated with changes in the elastic properties of the airways resulting in tracheomegaly or acquired tracheal diverticulum. Both entities have been linked to problems during intubation or ventilation of patients. However tracheal diverticulum has not been described previously as a cause of air leakage. Conclusion: Acquired tracheal diverticulum should be recognized as a cause of air leakage in the intubated patient, especially if associated with a normal or elevated intracuff pressure.

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Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks

Anesthesiology ◽

10.1097/aln.0000000000001710 ◽

2017 ◽

Vol 127 (2) ◽

pp. 307-316 ◽

Cited By ~ 7

Author(s):

Kurt Ruetzler ◽

Sandra Esther Guzzella ◽

David Werner Tscholl ◽

Tanja Restin ◽

Marco Cribari ◽

...

Keyword(s):

General Anesthesia ◽

Muscle Relaxation ◽

Intensive Therapy ◽

Airway Device ◽

University Hospital ◽

Supraglottic Airway ◽

Leak Pressure ◽

Supraglottic Airway Device ◽

Air Leak ◽

Supraglottic Airway Devices

Abstract Background Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. Methods The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. Results The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. Conclusions The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

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Results of the randomized comparative study of second-generation supraglottic airways in orbital osteosynthesis

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2019-16-6-46-53 ◽

2020 ◽

Vol 16 (6) ◽

pp. 46-53

Author(s):

I. V. Kostetskiy ◽

A. A. Shamrikov ◽

V. A. Bagin ◽

A. A. Kaliskin

Keyword(s):

Postoperative Complications ◽

Pulmonary Ventilation ◽

Peak Inspiratory Pressure ◽

Leak Pressure ◽

Oropharyngeal Leak Pressure ◽

Significant Difference ◽

Artificial Pulmonary Ventilation ◽

Lma Supreme ◽

Jaw Thrust Maneuver ◽

Equal Efficacy

The objective: to assess and compare supraglottic airways of LMA-Supreme and i-gel during orbital osteosynthesis.Subjects and methods. 91 patients were included into the study. All of them underwent osteosynthesis of the orbit. The patients were randomly divided into two groups. LMA-Supreme group included 42 patients, while i-gel group included 49 patients.Results. The parameters of hemodynamics, gas exchange, and artificial pulmonary ventilation (APV) did not basically differ between the groups at different stages of the study. The oropharyngeal leak pressure differed between the groups at the end of surgery and made (Me – median, Q1 and Q3 – upper and lower quartiles): 28.0 (22.0; 30.0) and 21.0 (19.0; 27.0) mm WG the LMA-Supreme and i-gel groups, respectively; p = 0.021. A significant difference was observed in the insertion time of supraglottic airways (Me is the median, Q1 and Q3 are the upper and lower quartiles): 27.5 (19.3; 36.5) sec. for LMA-Supreme and 15.0 (13.8; 25.0) sec. – for i-gel; p = 0.001. When inserting the LMA-Supreme duct in 33 (78.6%) patients, jaw thrust maneuver, extension of the neck, etc. were required; while in the i-gel group, similar maneuvers were necessary in 18 (36.7%) patients; p < 0.001. The number of postoperative complications was minimal in both groups.Conclusion. Both supraglottic airways can be used with equal efficacy in osteosynthesis of the orbit. At the same time, the i-gel duct has an advantage over the LMA-Supreme in speed and simplicity of insertion. The LMA-Supreme had greater leak pressure at the end of surgery, which might be an advantage in patients requiring greater peak inspiratory pressure to provide effective APV.

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Prospective Clinical and Fiberoptic Evaluation of the Supreme Laryngeal Mask Airway ™

Anesthesiology ◽

10.1097/aln.0b013e3181942c4d ◽

2009 ◽

Vol 110 (2) ◽

pp. 262-265 ◽

Cited By ~ 16

Author(s):

Arnd Timmermann ◽

Stefan Cremer ◽

Christoph Eich ◽

Stephan Kazmaier ◽

Anselm Bräuer ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Cuff Pressure ◽

Laryngeal Mask ◽

Leak Pressure ◽

Cuff Volume ◽

Oropharyngeal Leak Pressure ◽

Company Limited ◽

Patient Reported ◽

The Mean ◽

Lma Supreme

Background In March 2007, a new disposable laryngeal mask airway (LMA) became available. The LMA Supreme (The Laryngeal Mask Company Limited, St. Helier, Jersey, Channel Islands) aims to combine the LMA Fastrach feature of easy insertion with the gastric access and high oropharyngeal leak pressures of the LMA ProSeal. Methods The authors performed an evaluative study with the LMA Supreme, size 4, on 100 women to measure the ease of insertion, determinate the laryngeal fit by fiberoptic classification, evaluate the oropharyngeal leak pressure, and report adverse events. Results Insertion of the LMA Supreme was possible in 94 patients (94%) during the first attempt, and in 5 patients (5%) during the second attempt. In one small patient, the LMA Supreme could not be inserted because of limited pharyngeal space. This patient was excluded from further analysis. Insertion of a gastric tube was possible in all patients at the first attempt. The median time for LMA Supreme insertion was 10.0 s (+/-4.7 s; range, 8-30 s). Laryngeal fit, evaluated by fiberscopic view, was rated as optimal in all patients, both immediately after insertion of the LMA Supreme and at the end of surgery. After equalization to room pressure, the mean cuff volume needed to achieve 60 cm H2O cuff pressure was 18.4 ml (+/-3.8 ml; range, 8-31 ml). The mean oropharyngeal leak pressure at the level of 60 cm H2O cuff pressure was 28.1 cm H2O (+/-3.8 cm H2O, range, 21-35 cm H2O). Eight patients (8.1%) complained of a mild sore throat. No patient reported dysphagia or dysphonia. Conclusions Clinical evaluation of the LMA Supreme showed easy insertion, optimal laryngeal fit, and low airway morbidity. Oropharyngeal leak pressure results were comparable to earlier data from the LMA ProSeal.

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